eMedicine Specialties > Vascular Surgery > Medical Topics

Aortoiliac Occlusive Disease: Follow-up

Author: Kenneth E McIntyre, MD, Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine
Contributor Information and Disclosures

Updated: Oct 6, 2008

Outcome and Prognosis

Outcomes following aortic operations for aortoiliac occlusive disease (AIOD) are measured in terms of operative mortality rates and patency of the arterial reconstruction over time. These outcomes are similar for both aortoiliac TEA or AFB. The operative mortality rate (30-d) is 2-3%. Long-term patency is excellent too. The patency rate at 5 years following AFB or TEA is 85-90%. If patients continue to smoke, however, these excellent patency rates are reduced by half.

Outcomes for extra-anatomic (axillofemoral/femoral-femoral) bypasses are clearly not as good as either AFB or aortoiliac TEA. Operative mortality rates for extra-anatomic bypass might be expected to be better than AFB due to the extracavitary nature of these procedures and the fact that aortic occlusion is not required during the course of the operation. However, an operative mortality rate of 0-4% for femorofemoral bypass and 2-11% for axillobifemoral bypass is a reflection of the selected patients in whom these procedures are performed. Five-year primary patency of extra-anatomic bypasses performed for aortoiliac occlusive disease (AIOD) ranges from 19-50% for axillobifemoral bypass and 44-85% for femoral-femoral bypass.

Endovascular techniques (ie, percutaneous transluminal angioplasty, stent placement) offer alternatives to conventional surgical repair. Therefore, understanding the outcomes offered with such interventions is important. Although isolated stenosis of the infrarenal aorta or common iliac artery is uncommon, this lesion is suited ideally to percutaneous transluminal angioplasty (PTA) and/or stent placement. With localized, segmental occlusive disease in the aorta, initial technical success can be achieved in 95% of cases, with 5-year patency rates of 80-87% using percutaneous transluminal angioplasty (PTA). Initial success rates using percutaneous transluminal angioplasty (PTA) for iliac lesions are 93-97%, with 5-year patency rates of 54-85%. These results seem to be improved when arterial stents are used either primarily or as an adjunct to percutaneous transluminal angioplasty (PTA) for the treatment of iliac artery stenosis.

Future and Controversies

No controversy exists regarding the appropriate surgical procedure to treat aortoiliac occlusive disease (AIOD). Use TEA only in cases of type I atherosclerosis. TEA also is an excellent option for those patients with blue toe syndrome from severe ulcerogenic aortoiliac atherosclerosis that involves only the infrarenal aorta and common iliac arteries.

Some authors have advocated performing the aortic procedure through a retroperitoneal rather than an intra-abdominal approach. Unfortunately, despite some excellent work in this area, outcomes are similar whether the procedure is performed in a retroperitoneal or transabdominal fashion.

A more controversial area is whether proximal occlusive disease should be treated nonoperatively, using angioplasty and stent placement rather than the more invasive aortic operation. It seems clear that angioplasty and/or stent placement is a suitable alternative for patients with very focal occlusive disease in the common iliac artery but offers a poor alternative for more diffuse disease that involves the external iliac artery. Furthermore, the patency results for patients who have had total occlusions in the iliac arteries treated by endovascular therapy are definitely inferior to conventional surgical results.

The current controversy involves the appropriate place for minimally invasive treatment of aortoiliac occlusive disease (AIOD). Laparoscopically assisted AFBs have been performed both in animals and humans with satisfactory results. However, a significant learning curve seems to be involved, and no long-term follow-up data are available for review.

 


More on Aortoiliac Occlusive Disease

Overview: Aortoiliac Occlusive Disease
Workup: Aortoiliac Occlusive Disease
Treatment: Aortoiliac Occlusive Disease
Follow-up: Aortoiliac Occlusive Disease
Multimedia: Aortoiliac Occlusive Disease
References
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Further Reading

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Keywords

claudication, aortoiliac occlusive disease, vascular disease, AIOD, peripheral arterial disease, PAD, percutaneous transluminal angioplasty, PTA, thromboendarterectomy, TEA, blue toe syndrome, trash foot syndrome, stent, revascularization

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Contributor Information and Disclosures

Author

Kenneth E McIntyre, MD, Professor of Surgery, Chief, Division of Vascular Surgery, University of Nevada School of Medicine
Kenneth E McIntyre, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Southern Association for Vascular Surgery, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Lawrence Kaufman, MD, Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine
Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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